Department of Neurology, University Medicine Göttingen, Göttingen, Germany.
Anticancer Res. 2009 Dec;29(12):5191-5.
Patients with neoplastic meningitis (NM) from breast cancer have a median survival of 4-8 months with specific treatment. Here, good tolerance and long-term stabilization with combined intrathecal liposomal cytarabine (Ara-C), which is probably the most promising drug for intrathecal chemotherapy to date, near-continuous temozolomide and radiotherapy is reported in two patients with leptomeningeal and solid central nervous system (CNS) metastases from breast cancer.
A 42- and a 43-year-old female presented with NM and disseminated CNS metastases from human epidermal growth factor receptor type 2 (Her2)-positive breast cancer. After irradiation of the symptomatic sites, intrathecal liposomal Ara-C every 2-4 weeks was combined with temozolomide 100 mg/m(2) day 1-5/7. Cerebrospinal fluid (CSF) cytology and neurological symptoms improved in both patients and stabilized for several months. The patients survived 10 and 17 months after diagnosis of NM, without signs of neurological toxicity.
Intensive treatment is complicated by extensive pre-treatment and the lack of active CNS-penetrating systemic drugs. The long-term results with up to 17 intrathecal injections of liposomal Ara-C show that this treatment regimen is feasible and well-tolerated. The stabilization of both patients indicates activity of this combined intrathecal and systemic regimen that is based on long-term exposure of the tumour cells to both Ara-C and temozolomide. The results need to be confirmed prospectively.
接受特定治疗的乳腺癌所致神经恶性肿瘤（NM）患者的中位生存期为 4-8 个月。在此，报告了两例人表皮生长因子受体 2（Her2）阳性乳腺癌患者发生脑膜和实体中枢神经系统（CNS）转移伴 NM，其鞘内使用脂质体阿糖胞苷（Ara-C）、替莫唑胺和顺行性全脑放疗联合治疗具有良好的耐受性和长期稳定性，脂质体阿糖胞苷可能是迄今为止鞘内化疗最有前途的药物。
42 岁和 43 岁女性分别因 NM 和广泛 CNS 转移就诊，均为 Her2 阳性乳腺癌。症状性部位放疗后，每 2-4 周鞘内注射脂质体阿糖胞苷，同时给予替莫唑胺 100mg/m²，第 1-5/7 天给药。两例患者的 CSF 细胞学和神经症状均改善，并在数月内稳定。诊断为 NM 后，两名患者分别存活 10 个月和 17 个月，无神经毒性迹象。
强化治疗因广泛的预处理和缺乏有效的 CNS 穿透性全身药物而变得复杂。多达 17 次鞘内注射脂质体阿糖胞苷的长期结果表明，这种治疗方案是可行的且耐受良好。两名患者的稳定表明，该联合鞘内和全身治疗方案具有活性，该方案基于肿瘤细胞长期暴露于阿糖胞苷和替莫唑胺。结果需要前瞻性证实。
